Abstract Details

Title Utility and Feasibility of Portable Ultra-Low Field MRI in Patients with Progressive Multifocal Leukoencephalopathy

Topic Infectious Disease

Presentation(s) S38 - All Things HIV and ID (5:06 PM-5:18 PM)

Poster/Presentation
Number 009

Background PML is a debilitating central nervous system infection caused by JC virus. Recent development of portable ULF-MRI technology has potential implications for PML ‘point-of-care’ follow-up. There are no prior data on the feasibility and utility of ULF-MRI in detecting common imaging findings in PML.

Objective To investigate utility of portable ultra-low-field (64 mT) MRI (ULF-MRI) and determine the ability to visualize common imaging findings in patients with progressive multifocal leukoencephalopathy (PML) in comparison with high-field (HF, 3T) MRI.

Design/Methods Patients were recruited from the National Institutes of Health Natural History Study of PML (NCT01730131). 5 patients underwent HF-MRI (3T Philips) of the brain with contrast followed by ULF-MRI (Swoop, Hyperfine) in the same sitting, thus taking advantage of single-administration of gadolinium; 2 had ULF-MRI within 2 weeks of HF-MRI, in these cases performed without gadolinium. ULF-MRI was performed at bedside for one patient.Imaging sequences included T2-FLAIR, T1-weighted, and DWI. Scans were evaluated by a neuroradiologist and a neurologist with neuroimaging expertise. Analysis included detection of PML white matter lesions, and whether contrast enhancement and restricted diffusion could be visualized within these lesions.

Results 7 patients (3 women) with varying underlying diseases, including MS, HIV, and primary immune deficiency, participated in this pilot. 3 had active PML, 1 had PML-IRIS, and 3 were long-term survivors. Multifocal PML lesions were visualized on HF-MRI for all patients; 5/7 had supratentorial lesions only, while 2/7 had infratentorial disease. Corresponding lesions were identified in all cases on ULF-MRI with exception of punctate lesions, which were not consistently visualized. One subject (PML-IRIS) exhibited contrast enhancement on HF-MRI, clearly visualized on post-contrast ULF-MRI. No patients presented clear diffusion restriction on HF-MRI or ULF-MRI.

Conclusions ULF-MRI is feasible, even in bedside scans, and warrants continued investigation to define possible role in 'point-of-care' settings.

Authors/Disclosures
Karan D. Kawatra, Other PRESENTER	Mr. Kawatra has nothing to disclose.
	No disclosure on file
	No disclosure on file
Yair Mina, MD (Tel Aviv Medical Center)	Dr. Mina has nothing to disclose.
Anita M. Fletcher, MD (AdventHealth Neuroscience Institute)	Dr. Fletcher has nothing to disclose.
Shila Azodi, MD (FOOD AND DRUG ADMINISTRATION)	Dr. Azodi has nothing to disclose.
Daniel Reich, MD, PhD (National Institutes of Health, Neuroimmunology Branch, NINDS)	Dr. Reich has received research support from NIH. The institution of Dr. Reich has received research support from Adelson Medical Research Foundation. The institution of Dr. Reich has received research support from Sanofi-Genzyme. The institution of Dr. Reich has received research support from Abata Therapeutics. The institution of Dr. Reich has received research support from National Multiple Sclerosis Society. Dr. Reich has received personal compensation in the range of $500-$4,999 for serving as a CME Faculty with PeerView. Dr. Reich has received personal compensation in the range of $500-$4,999 for serving as a CME Faculty with AcademicCME. Dr. Reich has received personal compensation in the range of $500-$4,999 for serving as a CME Faculty with Integrity. Dr. Reich has a non-compensated relationship as a Advisor with Sanofi-Genzyme that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Board of Directors with ACTRIMS that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with Abata Therapeutics that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with American Brain Foundation that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with University of Basel RC2NB that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with Multiple Sclerosis Society of Canada that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with Tuscan Doctorate in Neuroscience that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Editorial Board with Multiple Sclerosis Journal that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with Biohaven that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with Sana that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with Merck KGaA EMD Serono that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with Bristol-Meyers Squibb that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with ChemoCentryx that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Collaborator, Advisor with Hyperfine that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Collaborator with Imaginab that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with Perceptive that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Collaborator with Annexon that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Collaborator, Advisor with Philips that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Collaborator with Siemens that is relevant to AAN interests or activities.
Govind Nair	No disclosure on file
Irene Cortese, MD	Dr. Cortese has stock in Keires, AG. Dr. Cortese has stock in Nouscom, AG. Dr. Cortese has stock in PDC Pharma. Dr. Cortese has a non-compensated relationship as a scientific advisor with Cellevolve that is relevant to AAN interests or activities.